1. Next Steps Robert A. Gabbay, MD, PhD
Professor of Medicine, Penn State College of Medicine

2. Until we meet again… Use your practice facilitator as a resource
Meet with and call Patty/Sharon: Pick a date today!
Reflect on and respond to their feedback
Continue (or start) holding weekly team meetings
Develop a plan to collect any data you don’t have or correct any data you know is wrong
Continue implementing:
Population alert
Use of template/flow sheet with embedded guidelines
Standing orders
Planned care at every visit

3. Until we meet again… Start testing self-management support
Patient report cards
Collaborative goal setting
Think about risk assessment and follow-up interventions for varying levels of risk
Frequency of visits
Follow-up phone calls
Clinical protocols
Identify diabetes patients overdue for visits and reach out to them to schedule a visit and provide follow-up care

4. Until we meet again…
Show significant and sustained improvement in at least 1 outcome measure and 3 process measures
Keep on reporting PDSAs, data, status reports
Participate in webinars: 4th Thursday of month (except for Nov and Dec), 12pm-1pm
Sept. 27 ▪ Oct. 25
Nov. 15 ▪ Dec. 20
Tell us what you need!

5. Monthly Report Due Dates
2012
2013
October 5
November 5
December 5
January 7
February 5
March 5
April 5
May 6
June 5

6. Learning Session #3 South Central Northwest
Jan. 29: 5-9pm at PSU College of Medicine, Hershey
Northwest
Jan. 22: 5-9pm at PSU Behrend, Erie

7. Practice Facilitators
Northwest
Patricia J. Stubber, MBA
Executive Director
Northwest PA AHEC
8425 Peach Street
Erie, PA
(phone)
(cell)
(fax)
South Central
Sharon M. Adams RN, BA
Executive Director
Southcentral PA AHEC
PO Box 509
Carrolltown, PA 15722
(phone)
(fax)
Web: